Kawamura S, Hadeishi H, Suzuki A, Yasui N
Department of Surgical Neurology, Research Institute for Brain and Blood Vessels-Akita.
Neurol Med Chir (Tokyo). 1998 Jan;38(1):12-8; discussion 18-9. doi: 10.2176/nmc.38.12.
Seven patients (mean age 57 years) developed arterial occlusive lesions following both wrapping and coating during surgery for unruptured aneurysms. Five patients had no risk factors for arteriosclerosis, and two had hypertension or diabetes mellitus. The aneurysms were located in the middle cerebral artery in four cases, and the internal carotid artery in three. Both 100%-cellulose cotton (Bemsheet) and cyanoacrylate glue (Biobond) were used as reinforcement materials. Postoperative angiography revealed complete clipping, and no parent artery stenoses, although one patient had a non-symptomatic diffuse narrowing in the entire carotid fork 7 days following surgery. Three patients had progressive stroke 4-5 weeks following surgery, and two had no symptoms. Both reinforcement materials were used as little as necessary in the last two patients, but they had either transient ischemic attacks or progressive stroke 2 months following surgery. Arterial steno-occlusion was confirmed angiographically in all patients. These vascular lesions were probably induced by both direct toxicity of the cyanoacrylate glue and fibrosis or granuloma formation caused by the cotton fibers. The observed angiographical reversibility suggests that the cyanoacrylate glue is more likely to be the cause of the lesions than the cotton fibers.
7例患者（平均年龄57岁）在未破裂动脉瘤手术的包裹和涂层过程中出现了动脉闭塞性病变。5例患者无动脉硬化危险因素，2例有高血压或糖尿病。动脉瘤4例位于大脑中动脉，3例位于颈内动脉。100%纤维素棉（Bemsheet）和氰基丙烯酸酯胶（Biobond）均用作加固材料。术后血管造影显示夹闭完全，且无供血动脉狭窄，尽管1例患者在术后7天整个颈动脉分叉处出现无症状性弥漫性狭窄。3例患者在术后4 - 5周出现进行性卒中，2例无症状。在最后2例患者中，两种加固材料均尽可能少用，但他们在术后2个月出现了短暂性脑缺血发作或进行性卒中。血管造影证实所有患者均有动脉狭窄闭塞。这些血管病变可能是由氰基丙烯酸酯胶的直接毒性以及棉纤维引起的纤维化或肉芽肿形成所致。观察到的血管造影可逆性表明，氰基丙烯酸酯胶比棉纤维更可能是病变的原因。
